Hospice Training Guide

MANAGE SYMPTOMS

Trouble Breathing or Shortness of Breath Shortness of breath is also called dyspnea. Patients often describe it as a feeling of not getting enough air or a feeling that you cannot catch your breath, as if the room is closing in or that there is not enough air in the room. Being short of breath can cause: • Fear, anxiety • Gasping • An inablity to keep doing an activity • A need to sit upright • Blue or grey color in lips, fingertips or toes, end of nose, or ears Stay calm and breathe slowly while you help the patient do the following things: • Sit up in a chair or recliner. • Raise head on pillows when lying in bed. • Sit with hands on knees or on the side of the bed leaning over. • Use oxygen if ordered, making sure it is turned on, the tubes or mask are in the right place on the patient’s face, the tube is not kinked, and no one is smoking.

Spiritual and emotional concerns may also cause pain. You may see this type of pain expressed through: • Questioning the meaning of life, belief systems, or the meaning of suffering. • Talking about feelings of being left by God/higher power, or being angry with God/higher power. • Having pain and/or other physical symptoms. • Being afraid to fall asleep at night or other fears. • Feeling a sense of emptiness or loss of direction.

CALL YOUR CARE TEAM IF:

• The patient develops new pain. • The patient experiences an increase in pain. • The patient is unable to take pain medications for any reason. • There are increased signs of discomfort for patients who cannot speak. • The patient experiences any side effects from medication. • The patient’s pain continues in spite of medication or other efforts.

• Take slow, deep breaths, breathing in (inhale) through the nose and breathing out (exhale) slowly and gently through pursed lips (lips that are “puckered” as if you were going to whistle). This breathing exercise is like blowing bubbles and will help restore good, slow, deeper breaths to the lungs. • Open a window, use a fan or an air conditioner, or gently fan a piece of paper several inches from the patient’s face to circulate the air near the patient. • Apply a cool cloth to head or neck.

• Give medication, including inhalers, nebuliz- ers, pills, or liquids as ordered. Your nurse will teach you how to use the medications properly. Sometimes a small dose of liquid morphine can also help. • Keep area quiet to decrease feelings of anxiety. • Use relaxing activities such as prayer, medita- tion, calming music, massage, or other things that have helped the patient be calm in the past. Your Care Team will be able to offer sug- gestions, like massage, relaxation exercises, or music therapy to help.

Seizures A seizure is a sudden surge of electrical activity in the brain that affects how a person feels or acts for a short time. On rare occasions, a seizure may last for several minutes. Before some seizures, there may be warning signs. A person may have a sense that something is wrong (have a strange feeling, tingling) and sometimes seizures come with no warning. A seizure can affect people in different ways. Some may be barely noticed, while others may cause the person to have uncontrolled movements of the whole body. Seizures may cause the person to fall to the floor or even become unconscious. After a seizure, the person may be very sleepy. This may last for a few seconds, minutes, or hours.

Some possible causes of seizures: • Medical condition or a dis ease • Prior head injury • Infections • Medications • Fever Some things you may see during a seizure: • Muscle jerking, twitching • Stiffening of the body • Bladder emptying, wetting • Blurred vision • Inability to speak or blurred speach • Unconsciousness, passing out • Eyes rolling back • Confusion, short memory loss • Blank stare

How to help: • Move any objects that the per- son may fall on or bump into. • Turn the person on their side if vomiting occurs. • Gently support the head by placing a pillow underneath. • Remove eye glasses if possible. • Do not put anything in their mouth and do not try to hold their tongue. • Give medications if ordered.

CALL YOUR CARE TEAM IF: • The patient has a new or unusual seizure, or new behavior after a seizure. • There is any injury to the patient during or after a seizure. • The patient’s seizure is not stopping. • There is an increase in seizure frequency or severity. • The patient’s supply of medications for seizures becomes low.

Call Your Care Team if: • The patient’s shortness of breath increases or does not get better with the usual treatments or medicines. • The patient needs to use more than the normal amount of medicine or treatments to relieve shortness of breath. • You think you need to increase the oxygen. DO NOT make any adjustments without consulting your Care Team first.

References: Berry P. Management of Other Symptoms at the End of Life. Hospice and Palliative Nursing Assistant Core Curriculum. Pitts- burgh, PA: The Hospice and Palliative Nurses Association; 2009:24:25. Core Curriculum for the Generalist Hospice and Palliative Nurse. 3rd ed. Dubuque, IA: Kendall/Hunt Publishing Company; 2010.

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